SouthWest Skill Center Admission Packet Allied Health Page 2

Transcription

1 Page 1 Student Name Contact # Select One: Medical Assistant Medical Interpreter - Spanish Phlebotomy For assistance: your questions to swsc.advisor@estrellamountain.edu or call (623) ADMISSION PROCESS Attend Information Session (Thursdays at 3 p.m.) or - If you cannot attend a session, advisor to schedule an appointment swsc.advisor@estrellamountain.edu Admission Packet can be downloaded at: center/admissions-packet Obtain Student ID number/ Apply for Program. You can do this from anywhere! 1) Visit main website at my.maricopa.edu. If you have never attended a college in the Maricopa County Community College District (MCCCD), select New Student? Start Here or if you have attended within MCCCD, select Student Center in Student Tools column to retrieve your student ID and MEID; apply for Admission, select Clock/ EMCC/ Term/ and Program; or 2) Visit EMCC Enrollment Services in person. Take Placement Test(s) at the Testing Center in Komatke Hall B Required Scores: 74 or higher in Reading and 23 or higher in Mathematics* NOTE: Items that will exempt you from placement testing include: Successful completion of RDG 091 or RDG 100 with a C or higher; Successful completion of MAT081 or higher with a C or higher; a college degree; (program manager will initial this document to approve exemption) For the Medical Interpreter Program-Spanish: Pre-requisite: A PASS on the Spanish written and oral exams to enter the program. Written exam is taken in the Testing Center and oral exam is conducted by a program instructor. Instructor will contact the student to schedule an appointment. Written & Oral Passed: (Provide slip showing pass) *Math score is not required for the Spanish Medical Interpreter Program* Complete Disclosure Acknowledgement Form. (Attached, page 6) Acknowledgement documents that can be viewed online at Complete Student Declaration of Citizenship or Status (Attached, page 7) Documents that can be used to complete this requirement include: Valid original Driver s License or-u.s. Certificate of Birth. Obtain Level One Finger Print Clearance Card Code: ARS Students must go to: and follow the online process. DPS: (602) Establish Account with Castle Branch Background Check (Instructions attached, page 11) Obtain BLS Provider or CPR Pro CPR Card (See page 2 for list of providers) Complete Health and Safety Documentation (page 8 for a list of documentation) Upload documentation of vaccines and/or lab results or declinations to each required field within Castle Branch. The Healthcare provider form MUST be signed by licensed healthcare examiner. (Download forms from Castle Branch) Complete Castle Branch background check and requirements with COMPLIANT results COMPLETED

2 Page 2 Schedule an appointment for intake with an advisor - swsc.advisor@estrellamountain.edu. or call Front Desk Attend an intake session ONLY when your packet is complete, you have all required documents, and you are ready to pay or have funding secured. Payment If you applied for and received financial aid, please have your Estimate Award letter at the time you submit your complete admission packet. The Estimate Letter can be found in your student account. The advisor will provide you with a Registration Form. You must take the Registration Form to Cashier services. After payment is made or funding is secured from third party vendor, please bring the signed Secured Funding Form with the completed packet back to the advisor and/or Reception Desk. The admission requirements and costs of Southwest Skill Center programs are subject to change. Students must consult with the advisor to ensure appropriate requirements are met. CPR Card Requirement and Acceptable Providers Having a current CPR card is required. It must be valid for one year from the start of the program. The training cannot be online and it must include hands-on training AED, Adult, Child and Infant CPR. Provided is a list of acceptable CPR provider cards. ISSUER SouthWest Skill Center American Heart Association American Safety & Health Institute (ASHI) LEVEL OF TRAINING CPR Pro (CPR for Professional Rescuer) Basic Life Support (BLS) Provider CPR Pro (CPR for Professional Rescuer) Financing Your Education

3 Page 3 Students are responsible for the total program cost, which includes tuition and fees, out-of-pocket expenses, and any additional expenses associated with this program. Each student is expected to secure sufficient financial aid or Agency funding, and/or an established payment plan during their enrollment. MEDICAL PROGRAM TUITION AND FEES MEDICAL ASSISTANT INTERPRETER SPANISH PHLEBOTOMY Registration Fee* $15.00 $15.00 $15.00 Tuition Clock Hour $4, (830 X $5) $ (170 X $5) $2, (410 X $5) Course Fees $ $ $ Commencement Fee $15.00 $15.00 $15.00 TOTAL Tuition & Fees+ $5, $ $2, *Registration fee is applied per fiscal year: July 1 June 30 th. If a student s program crosses over June 30 th, a 2 nd Registration Fee will be assessed. Add $ All tuition and fees are subject to change pending MCCCD Governing Board Approval. Additional Expense. Student will be responsible for obtaining a urine drug screen within a specified time. This screening is done on a random basis. Do NOT obtain a drug screen on your own as it cannot be used. Screen results from tests taken prior to the start of the program will not be accepted. Information concerning the urine drug test will be given at orientation. The charge for this testing is approximately $ A positive screen for any reason will require a review by the Medical Review Officer. Any student not cleared by the Medical Review Officer will be immediately withdrawn. A $36.50 externship fee will also apply prior to externship paid directly to My Clinical Exchange. Listed below are some options for how to finance your education. Agency Funding. Obtain required paperwork from agency (Maricopa or Phoenix Workforce Connection, Arizona Youth Resources, etc.) These agencies have specific criteria that must be met. Please work carefully with your agency. A firm obligation/intent to pay with student name and amount must be received from the agency prior to enrollment. Financial Aid. Only programs that are 600+ clock hours qualify for financial aid funding. Medical Assisting and Medical Billing & Coding are the only current programs that qualify. o Financial Aid processing takes approximately 4-6 weeks. o Apply online at Use EMCC/SWSC school code o A minimum of three (3) weeks prior to the start of the program, submit your Estimate Award Letter and COMPLETE packet. The Estimate Award Letter can be found in your student account. If the letter is not submitted three (3) weeks prior to the start of your program, you are liable for all tuition and fees until your financial aid has been completed.

4 Page 4 Pay In Full (Buy-In). Use cash, check, or credit card to pay in full at time of packet acceptance and admission into the program. Payment Plan (Buy-In). The student will be responsible for signing up for the Equal Payment Plan and make their first payment prior to the start of their program. The student will be required to make their payment by the 1 st of each month for the amount of their payment plan. MEDICAL MONTHLY PAYMENT (ROUNDED) ASSISTANT (Varies by length of the program) (MAP105) Payment plan amount (daytime) - $5, total payments. $ MEDICAL INTERPRETER SPANISH (MIP105) PHLEBOTOMY (PHB105) Payment plan amount - $ total payments $261.00/ $ Payment plan amount - $2, total payments $700.00/ $ Registration fee is applied per fiscal year: July 1 June 30 th. If a student s program crosses over June 30 th, a 2 nd Registration Fee will be assessed. Add $ All tuition and fees are subject to change pending MCCCD Governing Board Approval. Your Financial Account For your convenience, you can view account activity and make credit card payments at Credit card payments are also accepted via phone at (623) Verification of Complete Packet Schedule an appointment with the Advisor to review your packet. The advisor will make photocopies as required. They will verify that all admission requirements have been met by completing the Packet Intake Checklist. Partial packets will NOT be accepted. All packets must be hand delivered. NO exceptions. Submission of the packet does not guarantee admission. Admission is based on eligibility, completed documents, and space in the program.

5 Page 5 Maricopa Student Refund Program (MSRP) Once your packet is complete and you have secured your funding, your packet will be submitted for processing of registration. Your next step would be to set up your Maricopa Student Refund Program (MSRP) account. In the event that you would be due a refund, having the account in place may prevent delays for you. Money Network is processing all student refunds for the Maricopa Student refund Program (MSRP). To ensure you receive your student refunds, you will need to enroll with Money Network using this link: To set up your account, you will need the following information: Your student ID# Your date of birth Your OFFICIAL Maricopa Student address For more information: Nondiscrimination Policy The Maricopa County Community College District does not discriminate on the basis of race, religion, color, national origin, sex, handicap/disability, sexual orientation, age, or Vietnam era/disabled Veteran status in employment or in the application, admission, participation, access and treatment of persons in instructional or employment programs and activities. Disability Resource Center, Classroom Accommodations Students with disabilities who believe that they may need accommodations in a class or program must contact the Disability Resource Center (DRC) in Komatke-B at (623) or (623) , or (623) The manager of Disability Resource Center is responsible for determining a student s eligibility for services and will notify the faculty in writing of the accommodations requested. During the first class session, faculty members shall announce that students may meet with them during office hours if they need special accommodations for a disability. If you have a question or concern, please contact the DRC. For more information about accommodating students, visit the website at Notice The SouthWest Skill Center reserves the right to change, without notice, any materials, information, curriculum requirements, and regulations stated in this publication.

6 Page 6 Acknowledgement Signature Page It is important that you read the following that is available on the SouthWest Skill Center (SWSC) webpage regarding the areas identified below. Follow this pathway: EMCC Home > SouthWest Skill Center > Admission Packet > Important Admission Documents. I acknowledge that I have read the documentation provided on this SWSC webpage related to: (Please initial below) Underage of 18 and Certification Testing Criminal Background Identity Authentication Influenza Prior Education My Clinical Exchange/Fee for Externship Student ID Number College LEGAL NAME: Last Name First Name Middle Name Signature Date

7 Page 7 Student Declaration of Citizenship or Status State law now requires that a person who is not a citizen or legal resident of the United States or who is without lawful immigration status is not entitled to classification as an in-state student pursuant to A.R.S. Section or entitled to classification as a county resident pursuant to A.R.S. Section Although you have previously enrolled at this or another Maricopa County Community College, it is important that you provide this information, even if you have been asked to provide similar information in the past. Failure to provide the information requested below may result in your being now classified as an out-of-state student for tuition and fee purposes. The responsibility of providing the proper residency classification is placed upon the student. Any student who falsifies his/her residency may be subject to dismissal from the college and /or criminal action. Only those with a lawful presence in the US may qualify for Maricopa County Community College District scholarships or federal l financial aid. Any information you provide about your legal status when you apply for financial aid or scholarships may be subject to mandatory reporting to federal immigration authorities under Arizona Law, A.R.S , Student ID Number College LEGAL NAME: Last Name First Name Middle Name Date of Birth (mm/dd/yyyy) United States Citizen Legal Immigrant/Permanent Resident Alien Registration Number Date of Issue Date of Expiration Lawful refugee or Asylee Alien Registration Number Date of Issue Date of Expiration Legal Nonimmigrant Alien Registration Number Date of Issue Date of Expiration Do NOT quality for any of the above Country of Citizenship Arizona Department of Motor Vehicle License Number or Identification Number Date of Issue Date of Expiration I do not possess an Arizona Department of Motor Vehicle License or Identification Card By signing this declaration, I swear under penalty of perjury that the document(s) that I have submitted to demonstrate lawful presence in the United States are true and the information provided on this form is true and complete. Signature Date For additional information, visit All of the information on this form is confidential and in compliance with the Family Education Rights and Privacy Act of The Act s provisions are explained in the General Catalog.

8 Page 8 Explanation of Health and Safety Requirements Immunizations Students must be in compliance with immunization policies of the Allied Health Program in which they are enrolled. The Program Director will provide students with health requirements applicable to that program and the deadline by which students must submit proof of meeting such requirements. Students will meet these requirements by providing completed and signed Health and Safety Documentation Checklist with all accompanying required documentation and the Health Care Provider Signature Form. Women of childbearing age should only be vaccinated after review of the circumstances by a health care practitioner. Students will be responsible for the costs of completion for all immunization requirements. The following is a description of immunizations that may be required and the type of documentation that a student would have to provide to verify the requirements have been met. (See Exhibit A, Health and Safety Documentation) If there is a communicable disease outbreak, additional vaccinations may be required as specified by the local public health agency. Proof of all immunizations and tuberculin skin tests should be copied and attached to the Health Declaration form. MMR (measles, mumps and rubella): students born in 1957 or later must provide proof of one of the following: written proof of two MMR immunizations OR proof of a positive titer for each of these diseases. According to CDC recommendations students born before 1957 are generally felt to be immune but one dose of MMR vaccine should be given to anyone born before 1957 who does not have proof of positive titers to each of the three diseases. For programs that place students at Phoenix Children's Hospital students are required to show laboratory results documenting a positive titer for Measles/rubeola and rubella. Please contact program director to verify if this is a necessary requirement for the program you are entering. If a student has a NEGATIVE OR EQUIVOCAL titer result for all 3 components they must obtain their first MMR vaccination and attach documentation to their health and safety checklist. The second MMR must be completed after 28 days and proof submitted to the health care program. The student must then have titers drawn 30 days later and submit results to the healthcare program. Recommendations of the Centers for Disease Control and Prevention s Advisory Committee on Immunization Practices (ACIP), Adult Immunization Schedule 2014 Varicella (chickenpox): documented proof of a positive IgG titer OR if the titer is NEGATIVE obtain the first varicella vaccination and attach documentation to the Health and Safety Documentation form. The second varicella vaccination must be obtained 4 to 8 weeks later and proof submitted to the Program Director. Students are required to show laboratory results documenting a positive titer for varicella. History of disease is unacceptable. If a student has a NEGATIVE or EQUIVOCAL titer result, they must obtain their first varicella vaccination and attach documentation to their health and safety checklist. The second varicella vaccination must be completed 4 to 8 weeks later and proof submitted to the allied health program.

9 Page 9 The student must then have titers drawn 30 days later and submit results to the allied health program. Tetanus/Diphtheria: Tetanus, diphtheria and cellular pertussis (Tdap): Tdap=Tetanus/Diphtheria/Pertussis Proof of Tetanus, Diphtheria, and Pertussis immunity by submitting one of the following: Documentation of a Tdap booster immunization within the past 10 years OR Positive Antibody titers for ALL 3 component (Lab Report Required) If titer is negative or equivocal you must provide the titer result AND one Tdap Booster vaccine. Renewal date will be set for 10 years. Please note that DTaP immunization is a pediatric dose and not recommended for people over the age of 7. Hepatitis B: The Centers for Disease Control and Prevention have recommended that hepatitis B vaccine be considered for a number of groups including healthcare personnel at high risk for blood or needle stick exposure. It is highly recommended that students working in direct patient contact receive the hepatitis B vaccine. Students will be provided with information on protective and standard precautions as part of their Program curriculum, but students are advised to consult with their personal physician about the advisability of receiving the hepatitis B vaccine. To meet the requirements for Hepatitis B, students must either submit proof of completion of three Hepatitis B (see Exhibit A) injections OR a copy of proof of a positive HbsAB antibody titer OR a signed declination (see Exhibit B). If a student has not received injections in the past, he/she should receive an initial dose of hepatitis B with second and third vaccinations administered in 1 month and 6 month intervals. Recommendations of the Centers for Disease Control and Prevention s Advisory Committee on Immunization Practices (ACIP), Adult Immunization Schedule Influenza: An annual influenza vaccine is highly recommended by the Allied Health Programs. If a student declines this immunization for any reason, and a clinical agency requires such a vaccination there is the possibility that the student may not be permitted to participate in the clinical experience at that agency. Health care providers who are clinically or subclinically infected with influenza virus can transmit the virus to other persons including patients whose immune systems are compromised. As such many clinical facilities are requiring that all staff, students, and volunteers show proof of an annual influenza vaccination (see Exhibit B) or a signed declination (see Exhibit B). Recommendations of the Centers for Disease Control and Prevention s Advisory Committee on Immunization Practices (ACIP), Adult Immunization Schedule 2014 Tuberculosis Testing: For Allied Health students completing clinical experiences in a clinical agency, a Two Step Test* is required by the Allied Health Programs. *Two-step testing is used to reduce the likelihood that a boosted reaction will be misinterpreted as a recent infection. One of the following is required: Negative 2-Step TB skin test (two 1-step TB skin tests administered 1 to 3 weeks apart) or Past negative 2-step with each subsequent annual 1 step test (IF more than 12 months have passed between tests, then a new 2-Step TB test will be required or Negative quantiferon Gold Blood Test (lab report required) or If positive result, provide a Clear Chest X-Ray (lab report required) and TB Symptom Screen questionnaire.

10 Page 10 Renewal date will be set for one year, at which time, one of the following is required: 1-Step TB skin test or If positive result, a TB Symptom Screening Questionnaire is required. NOTE: A new Clear Chest X-Ray is required if last Chest X-Ray is more than 3 years old. Chest X-Rays are required every 3 years. The Tuberculosis Screening Questionnaire form must be provided each year for those with a positive TB test. This form is available in the requirement and must be downloaded, completed and uploaded to satisfy this requirement. TB Testing Documentation form is available for use, but not required for approval. Maricopa Community College District Nursing/ Allied Health Program Health & Safety Checklist is NOT acceptable documentation. QuantiFERON-G may be an appropriate test for TB in certain populations of persons who are at low risk or increased risk for latent tuberculosis infection. Students should check with the Program Director for more information. CDC. Guidelines for the investigation of contacts of persons with infectious tuberculosis: recommendations from the National Tuberculosis Controllers Association and CDC. MMWR 2005; 54(No. RR-15): Physical Exam/ Health Care Provider Signature: Download, print and complete the Physical Assessment Form provided on Castle Branch, signed by a physician (M.D. or D. O.), Nurse Practitioner, or Physicians' Assistant within the past 6 months. Place Order Select Program Select Package

11 Page 11 Southwest Skill Center How to Place Order Welcome to To place your order go to Package Name (if applicable) Medical Assistant: SJ11bgim - Background Check - Medical Document Manager Medical Assistant- Honor Health HHC: OH74bgim - Background Check, Document Manager Phlebotomy: SJ07bgim - Background Check - Medical Document Manager Spanish Medical Interpreting: SJ10bgim - Background Check - Medical Document Manager Place Order Select Program Select package To place your initial order, you will be prompted to create your secure mycb account. From within mycb, you will be able to: View order results Manage requirements Upload documents Place additional orders Complete tasks Please have ready personal identifying information needed for security purposes. The address you provide will become your username. Contact Us: or servicedesk.cu@castlebranch.com